Document Detail

Clinical reinfarction according to infarct location and reperfusion modality in patients with ST elevation myocardial infarction. A DANAMI-2 long-term follow-up substudy.
MedLine Citation:
PMID:  19005253     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To evaluate clinical reinfarction during a 3-year follow-up after randomization to primary angioplasty versus fibrinolysis in anterior and non-anterior ST elevation myocardial infarction (STEMI). METHODS: Clinical reinfarction was prospectively assessed by an endpoint committee blinded to the study treatment. RESULTS: At 30 days, primary angioplasty compared with fibrinolysis reduced the reinfarction rate both in anterior STEMI patients (n = 823; 2.5 vs. 5.6%, p = 0.02) and in non-anterior STEMI patients (n = 743; 0.8 vs. 7.4%, p < 0.001). After 3 years, the reduction in reinfarction rate was no longer present in anterior STEMI patients (11.2 vs. 11.2%, p = 0.86), but persisted in non-anterior STEMI patients (5.2 vs. 13.5%, p < 0.001). Reinfarction after anterior STEMI carried a higher mortality than reinfarction after non-anterior STEMI (37.6 vs. 15.3%, p = 0.01). Independent predictors of death were: age [hazard ratio (HR) per 1-year increase in age = 1.08 (1.07-1.09)], clinical reinfarction [HR = 5.15 (3.57-7.43)], anterior index STEMI [HR = 1.65 (1.24-2.19)], and Killip class > or =2 [HR = 1.42 (1.01-2.00)]. The additional late reinfarctions after angioplasty for anterior STEMI were located within the angioplasty-treated target segment. Anterior STEMI patients had smaller mean target vessel diameter, which was associated with reinfarction. CONCLUSIONS: Clinical reinfarction is an independent predictor of death. The early superiority of primary angioplasty over fibrinolysis on reinfarction rate after anterior STEMI diminished during long-term follow-up.
Martin Busk; Steen D Kristensen; Klaus Rasmussen; Henning Kelbaek; Per Thayssen; Jan K Madsen; Ulrik Abildgaard; Lars R Krusell; Leif S Mortensen; Leif Thuesen; Henning R Andersen; Torsten T Nielsen;
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-11-13
Journal Detail:
Title:  Cardiology     Volume:  113     ISSN:  1421-9751     ISO Abbreviation:  Cardiology     Publication Date:  2009  
Date Detail:
Created Date:  2009-04-02     Completed Date:  2009-07-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1266406     Medline TA:  Cardiology     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  72-80     Citation Subset:  IM    
Copyright Information:
Copyright 2008 S. Karger AG, Basel.
Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark.
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MeSH Terms
Denmark / epidemiology
Follow-Up Studies
Middle Aged
Multicenter Studies as Topic
Myocardial Infarction / etiology*,  mortality,  pathology
Myocardial Reperfusion / methods*
Myocardium / pathology*
Randomized Controlled Trials as Topic

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